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Related Experiment Video

Updated: Jan 22, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing.

Dominik Beer1, Parikshit S Sharma2, Faiz A Subzposh1

  • 1Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania.

JACC. Clinical Electrophysiology
|July 20, 2019
PubMed
Summary

Nonselective His bundle pacing (NS-HBP) showed similar clinical outcomes to selective His bundle pacing (S-HBP) regarding mortality and heart failure hospitalization. Further multicenter studies are needed to confirm these findings for His bundle pacing (HBP).

Keywords:
His bundle pacingheart failure hospitalizationmortalitynonselective HBPselective HBP

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • His bundle pacing (HBP) is the most physiologic ventricular pacing method.
  • Nonselective HBP (NS-HBP) can lead to right ventricular septal pre-excitation and wider QRS duration compared to selective HBP (S-HBP).

Purpose of the Study:

  • To compare the clinical outcomes of NS-HBP versus S-HBP in patients with bradyarrhythmic indications.

Main Methods:

  • A retrospective analysis of 350 patients from HBP registries who received HBP for bradyarrhythmia.
  • Patients were classified as NS-HBP (n=232) or S-HBP (n=118) based on QRS morphology at 3-month follow-up.
  • The primary outcome was a composite of all-cause mortality or heart failure hospitalization.

Main Results:

  • The NS-HBP group had a higher prevalence of male patients, infranodal AV block, ischemic cardiomyopathy, and permanent atrial fibrillation.
  • The primary endpoint occurred in 35% of NS-HBP patients versus 19% of S-HBP patients (HR 1.38; 95% CI 0.87-2.20; P=0.17).
  • Subgroup analyses in high-risk patients did not reveal an increased risk with NS-HBP.

Conclusions:

  • NS-HBP demonstrated comparable outcomes to S-HBP concerning mortality and heart failure hospitalization.
  • Multicenter, risk-matched studies are recommended to validate these findings in His bundle pacing.